Willingness to pay for avoiding coronary restenosis and repeat revascularization: results from a contingent valuation study

Abstract

Background: Despite technological improvements, percutaneous coronary intervention (PCI) remains limited by restenosis requiring further revascularization procedures during the ensuing year. New technologies aiming to reduce restenosis are expensive and may increase net healthcare costs. Economic evaluations of such therapies have been performed, but have been hindered by the need to assess the disutility of short-term health care events and repeat coronary revascularization as well as the lack of benchmark standards for intermediate health outcomes. The contingent valuation approach may offer particular advantages when evaluating treatments that improve short-term health outcomes. Objective: To examine patients’ willingness to pay (WTP) for treatments that may reduce the risk of restenosis and repeat revascularization after PCI. Methods: We used a contingent valuation approach to evaluate WTP among participants in two large clinical trials evaluating new PCI devices. The baseline scenario described a 30% probability of repeat revascularization following the initial procedure. Patients were asked to indicate, using a close-ended (referendum) question, their out of pocket WTP for an improved treatment that would reduce this risk. Three different prices ($ 500, $ 1000, and $ 1500) and three levels of absolute risk reduction (10, 20, and 30%) were randomly varied creating nine sub-samples of patients. Patients’ responses were analyzed using both parametric and non-parametric methods. Results: 1642 patients completed the WTP question. The WTP medians for the 10 and 20% risk reductions were $ 273 and $ 366, respectively; the median WTP for the 30% risk reduction was significantly higher at $ 1162 ( P<0.001). Higher household income (OR=1.57, P<0.001) was independently associated with a higher WTP. Conclusions: Although short-lived, avoidance of coronary restenosis may have considerable value to patients undergoing percutaneous coronary interventions. These findings may have important implications for emerging technologies such as drug-eluting stents.